Robots have big future in spine, but surgeon must have 'ultimate say in the OR,’ says Dr. Samer Shamieh


Covington, La.-based Avala hospital has four surgical robots, which it has used to perform more than 1,000 surgeries in less than two years.

K. Samer Shamieh, MD, medical director and lead spine surgeon at Avala, discussed expansion plans for the robotic surgery program and how robots will be used in the future.

Question: How has the robotics program advanced at Avala in the last two years? Do you have plans for more robots for spine or orthopedics?

Dr. K. Samer Shamieh: Avala's joint replacement and spine programs have exploded over the last two years since the investment of our four surgical robots. Avala has purchased the Globus Medical ExcelsiusGPS spine robot and is one of only 12 hospitals in the world to own three Stryker Mako robots.

Robotic-assisted surgery allows our surgeons to use minimally invasive techniques while taking precision to the next level. Our marketing allows us to get the word out to surrounding communities. If our projected surgery volume continues to rise, more robots will be on the way. Other service lines that could benefit from robotic-assisted surgery are urology, general surgery and gynecology. We have our eyes set on the da Vinci XI robot as a possible future addition to our robotics program.

Q: What does the future hold for robotics in spine? Do you see robots having greater autonomy in the OR? 

SS: The future is very exciting for robotic spine surgery. At this point, the robot mainly assists with the placement of pedicle screws. However, I believe that robots will soon be used for docking of retractors, drilling of bone as well as directing certain equipment to take away tissue from the spinal cord and nerves. Whatever the advancements, Avala will be at the forefront of robotic surgery.

As far as autonomy, my feeling is that the robot should only assist in the surgery. I feel that the best outcomes are achieved when the surgeon has the ultimate say in the operating room.

Q: How will robotics develop in spine as the industry looks for more value-based and cost-effective options to care?

SS: Robotic-assisted surgery allows for more personalized care. A CT scan is taken preoperatively to form a model of bone and spinal elements. That CT scan is utilized to map out where to place hardware, place retractors or even possibly remove compressive tissue away from spinal elements in the future. This precision will hopefully allow for fewer surgical errors with better fusions/decompressions and less reoperations, therefore leading to lower cost in the long run.

Q: What is the next big advancement you would like to see in minimally invasive spine surgery?

SS: There are two major categories of possible advancement in minimally invasive spine surgery. Strides in disc and cartilage regeneration in the facet joints seem to be a hot topic these days. But the next big advancement is joint and replacement surgery, which has exploded with the aging population. I would like to see facet joint replacement become a real option for surgeons. Advancement in the quality of lumbar disc replacement is going to be the next great step, as joint replacement is the future of spine surgery.

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